Against the background of political instability and chronic poverty, in 2000 Afghanistan experienced its worst drought for 30 years. Renewed offensives by the ruling fundamentalist Islamic Taliban in the north, displaced over 150,000 people. The drought killed thousands of livestock and caused a serious food crisis. After twenty years of war, health care in Afghanistan has been shattered, many areas are inaccessible and epidemics are common. A young boy lost his leg three months ago. He was a Talibansoldier untill he stepped on a mine somewhere at the frontline. Now he is back at his homevillage because they can't use him anymore at the front. He blams himself for being stupid to fighting in the war. Badghis Province around Bala Morghab,Afghanistan. November 2000

October 7, 2006 - 12:00pm

Doctors Without Borders/Médecins Sans Frontières (MSF) is an international independent medical humanitarian organization that delivers emergency aid to people affected by armed conflict, epidemics, natural and man-made disasters, and exclusion from health care in more that 75 countries.

MSF was founded in 1971 as the first non-governmental organization to both provide emergency medical assistance and bear witness publicly to the plight of people it assists. A private nonprofit association, MSF is an international network with sections in 19 countries.

MSF began working in Afghanistan in 1980, shortly after the Soviet invasion. Small medical teams undertook clandestine cross-border operations to reach people stranded in areas hardest-hit by the turmoil. MSF continued to open programs over the next 24 years: conducting surgery as fighting raged in Kabul during the mujahadeen wars; providing medical care to women and advocating on their behalf during the rise of the Taliban; and running clinics for people displaced by the fighting during the Taliban years and in the aftermath of the US-led military intervention.

On June 2, 2004, five MSF aid workers were assassinated while traveling in a clearly marked MSF vehicle. At the time, 80 MSF international volunteers and 1,400 Afghan staff were providing health care in 13 provinces. These teams faced an increasingly violent and chaotic environment, in which aid workers had become targets for military factions, and where the lines between military and humanitarian action had become increasingly blurred. Unable to ensure the security of its teams, MSF closed all of its medical programs in Afghanistan in July 2004.

Soviet Occupation (1979-1989)

Following the Soviet invasion of Afghanistan, MSF sends medical teams to Pakistan to assess the needs of Afghan refugees. The teams learn of critical conditions inside Afghanistan and decide to concentrate their efforts within the country.

From Peshawar, Pakistan, small teams of doctors and nurses organize mule trains and negotiate security agreements with local mujahadeen commanders. A journey of several weeks takes them to the northeastern provinces of Paktia and Nuristan, where they provide medical care from May until October, leaving before the heavy snowfall begins.

Over the next ten years, MSF expands its reach to eight provinces. Volunteers conduct surgery, provide primary care in makeshift clinics, and mount vaccination campaigns targeting children. They build and support local hospitals, training staff and bringing supplies. Throughout this period, Soviet forces frequently bomb medical facilities.

In 1986, MSF begins to assist Afghan refugees in Pakistan, where hundreds of thousands of people have sought sanctuary from the fighting.

Civil War (1989-1996)

After the last Soviet soldiers leave Afghanistan in February 1989, the mujahadeen set their sights on overthrowing the Communist government in Kabul. With the killing of MSF logistician Frederic Galland in April 1990 in Badakshan, MSF suspends all operations.

In 1992, fighting rages in Kabul as the mujahadeen launch their final offensive against the government. Reacting to the mounting casualties, MSF airlifts a surgical team and 20 tons of medical supplies into the capital to treat war wounded. In northern Afghanistan, MSF teams assist Tajik refugees fleeing civil war in their country.

After the ouster of the government, mujahadeen commanders turn against one another in a grab for power. With fighting taking place in Kabul and elsewhere, MSF expands its medical programs to the hardest-hit areas. Activities include primary health care, water-and-sanitation programs, mother-and-child health care, malaria and cholera treatment, vaccination campaigns, and hospital support and rehabilitation.

Taliban Regime (1996-2001)

In September 1996, the Taliban seizes control of Kabul and institutes an extreme interpretation of Islamic law. At the time, MSF is operating in 11 provinces across the country, working in internally displaced persons camps and camps for Turkmen refugees, training local staff, and supplying hospitals.

MSF volunteers increasingly treat landmine victims and provide information from the frontlines to an international advocacy movement aimed at banning these weapons. The organization clashes with the Taliban throughout this period over edicts restricting women’s access to medical care.

Against a backdrop of ongoing conflict, Afghans endure food shortages, drought, and epidemic outbreaks of cholera and scurvy. MSF teams respond continually to emergencies and assist people in as many as 15 provinces and in refugee camps in Pakistan. Conditions worsen as the Taliban and Northern Alliance fight ferocious battles in the north, displacing more Afghans.

US Intervention (2001-2004)

In the days after the September 11, 2001, attacks, all MSF international volunteers working in Taliban-controlled areas evacuate, while programs continue in the hands of Afghan staff. In November, MSF volunteers are among the first to return after US forces dislodge the Taliban.

In 2002, the return of more than two million Afghan refugees exceeds the war-ravaged country’s capacity to absorb them. More than 100 MSF international volunteers and 1,000 Afghan staff treat 45,000 patients in 16 provinces. In the north, teams care for 4,000 children in feeding centers and distribute food to people at risk of malnutrition.

As war continues in the south, insurgents deliberately kill aid workers and other civilians as a strategy of war against the US-led Coalition forces and the government of President Hamid Karzai. At the same time, the US government’s strategy of combining relief and military operations increases the vulnerability of humanitarian aid workers, whose work is now perceived as a component of the military effort.

With the killing of five MSF aid workers in June 2004, MSF withdraws from the country after 24 years.